High-quality Mental Health Services Research Articles (Page 1)

Increasingly, adolescents are struggling with poor mental health outcomes, making it essential to improve access to high-quality mental health services. Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) act as key "safety-net" health centers for low-income youth seeking mental health services, as the majority accept Medicaid. This study examines how administrative burdens, i.e., challenges citizens face when interacting with a government agency, may act as barriers to accessing mental health services, especially for adolescents and their caregivers. This exploratory sequential mixed-methods study uses data from semi-structured interviews with hospital- and community-based social workers, and from a mystery shopper study conducted during the COVID-19 pandemic with CMHCs and FQHCs in a large metropolitan county in the United States. It addresses three questions: (1) what kinds of administrative burdens exist in accessing mental health care for adolescents and their families at FQHCs and CMHCs? (2) how do these burdens convey potential learning, compliance, and psychological costs to prospective clients? (3) how do these burdens act as distinct barriers to accessing mental health services for adolescents and their families within safety-net health centers? Moreso than CMHCs, FQHCs implemented a variety of administrative burdens on prospective clients, such as a requirement to designate their primary care physician into the FQHCs network through their insurance prior to scheduling, difficult-to-navigate phone trees, unanswered voicemails, rude or discriminatory interactions with schedulers, and complex referral processes. This study finds that administrative burdens may act as distinct barriers to accessing mental healthcare. Recommendations to reduce administrative burdens at the organizational- and system-levels are discussed.

Among youth in residential youth care (RYC) there is a high load of experienced adversities and a high prevalence of mental disorders. Less is known about the stability and change of mental disorders and whether individual or contextual factors that are protective of adult mental disorders could be identified. The current study is a 10-year follow-up of young adults with a history of RYC in Norway. At baseline (T1), 76% met criteria of a mental disorder. At follow-up (T2), diagnostic psychiatric interviews were conducted by phone by experienced doctors and psychologists. A response rate of 52% was achieved (n=157). Criteria for at least one present mental disorder were fulfilled by 77.6%. The most prevalent single disorders were PTSD (42.1%), agoraphobia (33.3%), social phobia (27.9%), major depressive episode (23.1%), specific phobia (21.1%), and ADHD (19.2%). Most participants had more than one mental disorder. Among those with a diagnosis at T1, completing high school was the only factor found to be associated with no diagnosis at T2 (p=0.019), whereas no statistically significant association was found with sex, age at first placement and received aftercare. We found a very high prevalence of mental disorders and a high rate of comorbidity comparable to the prevalence at baseline. This shows high stability of psychopathology from adolescence into adulthood. Ensuring access to high quality mental health services for young adults with a history of living in RYC is important. Prevention and early intervention, such as aid to complete education, should be prioritized for young people with high risk of developing mental disorders. Response rate, sample size and selection bias are discussed as possible limitations to the study.

Youth depression is a critical target for early intervention due to its strong links with adult depression and long-term functional impairment. In low- and middle-income countries (LMICs) like the Philippines, limited epidemiological data hampers mental health service planning for youth. This study analyzed nationally representative survey data from 2013 (n = 19,178) and 2021 (n = 10,949) to estimate the prevalence of moderate to severe depressive symptoms (MSDS) among Filipinos aged 15–24 years, using the 11-item version of the Center for Epidemiologic Studies Depression Scale. Survey-weighted analyses revealed that MSDS prevalence more than doubled from 9.6% in 2013 to 20.9% in 2021. The rise was most pronounced among females (10.8% to 24.3%), non-cisgender or homonormative individuals (9.7% to 32.3%), youth with primary education or less (10.8% to 26.5%), youth from economically disadvantaged households (10.6% to 25.1%) and youth who were separated, widowed or divorced (18.3% to 41.3%). Disparities in MSDS also widened over time, with some groups bearing a disproportionate burden. These findings underscore the need to expand accessible, high-quality mental health services for youth in LMICs, such as the Philippines. Continued monitoring and targeted interventions are essential to address the rising burden of depression, particularly among underserved and disproportionately affected groups.

Ensuring ethical and competent practice in clinical psychology is fundamental to delivering high-quality mental health services. This article investigates the interplay between professional competence and ethical standards through a comprehensive literature review and qualitative interviews with four experienced clinical psychologists from Malaysia, the UAE, Sudan, and Kashmir. Key focus areas include the importance of robust educational foundations, continuous professional development (CPD), effective supervision and mentorship, and proficiency in evidence-based therapeutic modalities such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). Additionally, the report addresses core ethical challenges, including maintaining professional boundaries, ensuring confidentiality in the digital age, fostering cultural competency, and managing the ethical implications of emerging technologies. Findings highlight that a balanced integration of rigorous training, ongoing education, and ethical vigilance is crucial for enhancing clinical competence and upholding ethical standards. The report recommends implementing comprehensive training programs, improving accessibility to CPD, strengthening mentorship frameworks, and promoting self-care practices among practitioners to support sustained professional integrity and effective therapeutic outcomes. This research contributes to the field by providing actionable strategies for advancing both competency and ethical practices in clinical psychology, ensuring culturally sensitive and ethically responsible mental health care.

Mental health concerns have become increasingly prevalent; however, care remains inaccessible to many. While digital mental health interventions offer a promising solution, self-help and even coached apps have not fully addressed the challenge. There is now a growing interest in hybrid, or blended, care approaches that use apps as tools to augment, rather than to entirely guide, care. The Digital Clinic is one such model, designed to increase access to high-quality mental health services. To assess the feasibility, acceptability, and potential efficacy of the Digital Clinic model, this study aims to conduct a nonrandomized open trial with participants experiencing depression, anxiety, or both, at various levels of clinical severity. Clinicians were trained in conducting brief transdiagnostic evidence-based treatment augmented by a mental health app (mindLAMP); digital navigators were trained in supporting participants' app engagement and digital literacy while also sharing app data with both patients and clinicians. Feasibility and acceptability of this 8-week program were assessed against a range of benchmarks. Potential efficacy was assessed by calculating pre-post change in symptoms of depression (Patient Health Questionnaire-9; PHQ-9), anxiety (7-item Generalized Anxiety Disorder; GAD-7), and comorbid depression and anxiety (Patient Health Questionnaire Anxiety and Depression Scale; PHQ-ADS), as well as rates of clinically meaningful improvement and remission. Secondary outcomes included change in functional impairment, self-efficacy in managing emotions, and flourishing. Of the 258 enrolled participants, 215 (83.3%) completed the 8-week program. Most were White (n=151, 70.2%) and identified as cisgender women (n=136, 63.3%), with a mean age of 41 (SD 14) years. Feasibility and acceptability were good to excellent across a range of domains. The program demonstrated potential efficacy: the average PHQ-9 score was moderate to moderately severe at baseline (mean 13.39, SD 4.53) and decreased to subclinical (mean 7.79, SD 4.61) by the end of the intervention (t126=12.50, P<.001, Cohen d=1.11). Similarly, the average GAD-7 score decreased from moderate at baseline (mean 12.93, SD 3.67) to subclinical (mean 7.35, SD 4.19) by the end of the intervention (t113=13, P<.001, Cohen d=1.22). Participation in the program was also associated with high rates of clinically significant improvement and remission. Results suggest that the Digital Clinic model is feasible, acceptable, and potentially efficacious, warranting a future randomized controlled trial to establish the efficacy of this innovative model of care.

The aim of this study is to analyze the state of medical care provision during the war in Ukraine. To conduct a comprehensive analysis of the situation in Ukraine’s healthcare system over nearly three years of war, we performed a content analysis of sources dedicated to studying the state of the medical sector under wartime conditions in Ukraine. Russia’s failed attempt to capture Kyiv altered the nature of its military actions, leading to systematic and targeted bombings of Ukraine’s civilian infrastructure, including healthcare facilities. Despite the ongoing full-scale war, efforts to restore and reconstruct medical infrastructure continue, along with initiatives to ensure energy independence for primary healthcare facilities. Currently, many hospitals are equipped with shelters where doctors can provide the necessary, qualified medical assistance. Urgent and complex surgical procedures, planned transplantations, and blood donation services continue. The Medical Guarantees Program (MGP) not only remains operational during the war but also introduces new service packages. The development of a rehabilitation system in the healthcare sector continues, particularly for war victims and veterans. Significant attention is given to psychological support for the population. The National Mental Health and Psychosocial Support Program has been launched to build an effective system of high-quality and accessible mental health services. Ukraine’s healthcare system continues to function under wartime conditions, demonstrating resilience and adaptability. Despite the challenges, it responds rapidly to the needs and demands of the population.

Youth depression is a critical target for early intervention due to its strong links with adult depression and long-term functional impairment. In low- and middle-income countries (LMICs) like the Philippines, limited epidemiological data hampers mental health service planning for youth. This study analyzed nationally representative survey data from 2013 (n=10,949) and 2021 (n=19,178) to estimate the prevalence of moderate to severe depressive symptoms (MSDS) among Filipinos aged 15-24years, using the 11-item version of the Center for Epidemiologic Studies Depression Scale. Survey-weighted analyses revealed that MSDS prevalence more than doubled from 9.6% in 2013 to 20.9% in 2021. The rise was most pronounced among females (10.8% to 24.3%), non-cisgender or homonormative individuals (9.7% to 32.3%), youth with primary education or less (10.8% to 26.5%), youth from economically disadvantaged households (10.6% to 25.1%) and youth who were separated, widowed or divorced (18.3% to 41.3%). Disparities in MSDS also widened over time, with some groups bearing a disproportionate burden. These findings underscore the need to expand accessible, high-quality mental health services for youth in LMICs, such as the Philippines. Continued monitoring and targeted interventions are essential to address the rising burden of depression, particularly among underserved and disproportionately affected groups.

With the progress of social civilization and the improvement of mental health awareness, the public's demand for high-quality mental health services has increased significantly. The complexity and professionalism of the mental health field requires psychiatric nurses to have a set of core competencies to ensure that they can provide high quality, safe care to their patients. At present, the overall level of core competence of psychiatric nurses in China is in the middle stage, in which the ability of ethics and legal practice is more prominent, but the ability of thinking and scientific research is relatively weak. The high scores of ethics and legal practice ability reflect that nurses in psychiatric specialties in China attach great importance to industry norms and patients' rights and interests. The lack of critical thinking ability and scientific research ability means that nurses' judgment and innovative problem-solving ability in the face of complex clinical situations need to be strengthened, which also limits their participation in nursing scientific research and the promotion of disciplinary progress. Drawing on the mature experience of foreign countries and combining with China's national conditions, hospitals should clarify the responsibilities of nurses, strengthen training, especially in critical thinking and scientific research literacy, build a supportive interdisciplinary work environment, and establish a professional certification system. In order to comprehensively enhance the core competence of psychiatric nurses, improve the quality of life of patients, meet the needs of high-quality mental health services, cope with the challenges in the field of mental health, and promote the field of mental health nursing in China to a higher level.

School systems need practical and effective quality improvement strategies to advance school mental health promotion, prevention, and treatment services. Collectively, these efforts can be used to promote child and adolescent mental health, well-being, and academic success. The current study reports on the feasibility, initial impacts of, and recommendations from a national, multi-level learning collaborative conducted by the National Center for School Mental Health, University of Maryland School of Medicine and administered throughout the United States. The mixed-methods evaluation results support the feasibility of a learning collaborative and reinforce its positive initial impact on comprehensive school mental health system change. Participants indicated comprehensive school mental health quality improvements such as collaboration across diverse partners and spread of evidence-informed best practices that support high-quality services for students. The multi-level learning collaborative model is promising for future efforts to advance the dissemination of comprehensive school mental health systems and other state and local system change efforts. School mental health learning collaboratives may help address the ongoing youth mental health crisis by promoting high-quality mental health supports and services for youth.

The COVID-19 pandemic has intensified global mental health challenges, particularly for vulnerable groups like female entertainment workers (FEWs), a critical HIV-affected population in Cambodia. Already facing pre-existing inequalities, FEWs encountered heightened difficulties due to the pandemic's disruption of their livelihoods. Their susceptibility to mental health problems is exacerbated by poverty and the occupational stressors they regularly endure. This study aims to identify COVID-19-related factors adversely impacting the mental well-being of FEWs in Cambodia and explore potential interventions to mitigate these effects. In December 2021, we conducted a two-day workshop in Phnom Penh using a group model-building approach with stakeholders from diverse backgrounds to gather collective insights. We employed the qualitative system dynamics method of causal loop diagram mapping to visualize the factors affecting FEWs' mental health. Based on participants' perceptions and experiences, we constructed a causal loop diagram to develop a comprehensive systems perspective. The workshop involved 27 stakeholders, including representatives from national institutions (n = 3), local NGOs (n = 17), an international NGO (n = 1), and the FEW community (n = 6). Our analysis identified 13 feedback loops highlighting key factors influencing the mental well-being of FEWs during the pandemic. These factors included the loss of family members, financial instability, fear of COVID-19 infection, the pressure of children's homeschooling due to school closures, and food insecurity. In response, stakeholders proposed a range of interventions, including alternative vocational training, increased awareness of mental health issues, access to mental health services, and programs targeting gender-based violence within FEW communities. A collaborative, multi-sectoral approach is crucial to addressing the mental health challenges of FEWs in Cambodia. Prioritizing the establishment of accessible, affordable, and high-quality mental health services, alongside the implementation of targeted interventions, is essential to mitigate the negative mental health impacts of the pandemic and enhance the overall well-being of FEWs.

The mental health of children/young people is a growing concern internationally. Numerous reports and reviews have consistently described United Kingdom children's mental health services as fragmented, variable, inaccessible and lacking an evidence base. Little is known about the effectiveness of, and implementation complexities associated with, service models for children/young people experiencing 'common' mental health problems like anxiety, depression, attention deficit hyperactivity disorder and self-harm. To develop a model for high-quality service design for children/young people experiencing common mental health problems by identifying available services, barriers and enablers to access, and the effectiveness, cost effectiveness and acceptability of such services. Evidence syntheses with primary research, using a sequential, mixed-methods design. Inter-related scoping and integrative reviews were conducted alongside a map of relevant services across England and Wales, followed by a collective case study of English and Welsh services. Global (systematic reviews); England and Wales (service map; case study). Literature reviews: relevant bibliographic databases and grey literature. Service map: online survey and offline desk research. Case study: 108 participants (41 children/young people, 26 parents, 41 staff) across nine case study sites. A single literature search informed both reviews. The service map was obtained from an online survey and internet searches. Case study sites were sampled from the service map; because of coronavirus disease 2019, case study data were collected remotely. 'Young co-researchers' assisted with case study data collection. The integrative review and case study data were synthesised using the 'weaving' approach of 'integration through narrative'. A service model typology was derived from the scoping review. The integrative review found effectiveness evidence for collaborative care, outreach approaches, brief intervention services and the 'availability, responsiveness and continuity' framework. There was cost-effectiveness evidence only for collaborative care. No service model appeared to be more acceptable than others. The service map identified 154 English and Welsh services. Three themes emerged from the case study data: 'pathways to support'; 'service engagement'; and 'learning and understanding'. The integrative review and case study data were synthesised into a coproduced model of high-quality service provision for children/young people experiencing common mental health problems. Defining 'service model' was a challenge. Some service initiatives were too new to have filtered through into the literature or service map. Coronavirus disease 2019 brought about a surge in remote/digital services which were under-represented in the literature. A dearth of relevant studies meant few cost-effectiveness conclusions could be drawn. There was no strong evidence to suggest any existing service model was better than another. Instead, we developed a coproduced, evidence-based model that incorporates the fundamental components necessary for high-quality children's mental health services and which has utility for policy, practice and research. Future work should focus on: the potential of our model to assist in designing, delivering and auditing children's mental health services; reasons for non-engagement in services; the cost effectiveness of different approaches in children's mental health; the advantages/disadvantages of digital/remote platforms in delivering services; understanding how and what the statutory sector might learn from the non-statutory sector regarding choice, personalisation and flexibility. This study is registered as PROSPERO CRD42018106219. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/08) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 13. See the NIHR Funding and Awards website for further award information.

Background and Aims:There is no data on the treatment gap and health care utilization for mental disorders from Punjab. The present study reports on the same by using the data collected during the National Mental Health Survey.Settings and Design:Multisite, multistage, stratified, random cluster sampling study conducted in four districts, namely Faridkot, Moga, Patiala, and Ludhiana (for urban metro areas). Data were collected from October 2015 to March 2016.Materials and Methods:Mini International Neuropsychiatric Interview 6.0.0 and Adapted Fagerstrom Nicotine Dependence Scale were used to diagnose mental and behavioral disorders and tobacco use disorder, respectively. Pathways Interview Schedule of the World Health Organization was applied to persons having any disorder to assess treatment gap and health care utilization. Exploratory focused group discussions (FGDs) were conducted to understand the community perceptions regarding mental and behavioral disorders.Results:The treatment gap for mental and behavioral disorders was 79.59%, and it was higher for common mental disorders than severe mental disorders and higher for alcohol and tobacco use disorders as compared to opioid use disorders. The median treatment lag was 6 months. Only seven patients out of 79 were taking treatment from a psychiatrist, and the average distance traveled by the patient for treatment was 37.61 ± 45.5 km. Many attitudinal, structural, and other barriers leading to high treatment gaps were identified during FGDs in the community, such as stigma, poor knowledge about mental health, deficiency of psychiatrists, and distance from the hospital.Conclusions:Vertical as well as horizontal multisectoral integration is required to reduce the treatment gap and improve healthcare utilization. Increasing mental health literacy, providing high-quality mental health services at the primary-healthcare level and human resources development are the need of the hour.

A reflection of the current status of the mental healthcare system in South Africa

Prenatal maternal stress and mental health problems are known to increase risk for developmental psychopathology in offspring, yet pathways leading to risk or resiliency are poorly understood. In a quasi-experimental design, we prospectively examined associations between disaster-related prenatal stress, maternal mental health symptoms, and infant temperament outcomes. Mothers who were pregnant during Hurricane Harvey (N = 527) reported on objective hardships (e.g., loss of belongings or income, evacuation, home flooding) related to the storm and subsequent mental health symptoms (anxiety/depression, posttraumatic stress) across time. At a postpartum assessment, mothers reported on their infant's temperament (negative affect, positive affect, orienting/regulatory capacity). Greater objective hardship indirectly predicted higher levels of infant orienting/regulatory capacity through its association with increased maternal posttraumatic stress symptoms. Greater objective hardship also indirectly predicted higher levels of infant negative affect through its association with increased maternal anxiety/depression symptoms across time. Our findings suggest a psychological mechanism linking prenatal stress with specific temperamental characteristics via maternal mental health symptoms. Findings point to the importance of high-quality assessment and mental health services for vulnerable women and young children.

Primary Care Mental Health Services (PMHCS) aim to provide accessible and effective psychological interventions. However, there is a scarcity of qualitative research focused on patients' experiences. Service users' experience can inform development of accessible, high-quality mental health services. Nine semi-structured interviews were analysed from Primary Care Mental Health users in Northern Scotland using Interpretative Phenomenological Analysis (IPA). Four superordinate themes were generated: Orientating to treatment, Intervention features, Change enablers, and Impact. The results identified both facilitators and barriers associated with access and psychological change; and narratives around CBT acceptability, outcomes and remote delivery. The role of GPs emerged as a key determinant of access to PMHCS. The therapeutic relationship contributed to person-centred care provision, idiosyncratic change processes and self-empowerment. A personal commitment to engage with homework was described as a crucial change enabler. Findings are discussed in relation to existing literature, practical implications and suggestions for future research.

Primary Care Mental Health Services (PMHCS) aim to provide accessible and effective psychological interventions. However, there is a scarcity of qualitative research focused on patients’ experiences. Service users’ experience can inform development of accessible, high-quality mental health services. Nine semi-structured interviews were analysed from Primary Care Mental Health users in Northern Scotland using Interpretative Phenomenological Analysis (IPA). Four superordinate themes were generated: Orientating to treatment, Intervention features, Change enablers, and Impact. The results identified both facilitators and barriers associated with access and psychological change; and narratives around CBT acceptability, outcomes and remote delivery. The role of GPs emerged as a key determinant of access to PMHCS. The therapeutic relationship contributed to person-centred care provision, idiosyncratic change processes and self-empowerment. A personal commitment to engage with homework was described as a crucial change enabler. Findings are discussed in relation to existing literature, practical implications and suggestions for future research.

Increasing suicide rates and emergency department (ED) mental health visits reflect deteriorating mental health among American youth. This population-based study analyzes trends in ED visits for suicidal ideation (SI) before and during the coronavirus disease 2019 (COVID-19) pandemic. We analyzed Illinois hospital administrative data for ED visits coded for SI from January 2016 to June 2021 for youth aged 5 to 19 years. We characterized trends in patient sociodemographic and clinical characteristics, comparing three equal 22 month periods and analyzed patient and hospital characteristics associated with the likelihood of hospitalization. There were 81 051 ED visits coded for SI at 205 Illinois hospitals; 24.6% resulted in hospitalization. SI visits accounted for $785 million in charges and 145 160 hospital days over 66 months. ED SI visits increased 59% from 2016 through 2017 to 2019 through 2021, with a corresponding increase from 34.6% to 44.3% of SI principal diagnosis visits (both P < .001). Hospitalizations increased 57% between prepandemic fall 2019 and fall 2020 (P = .003). After controlling for demographic and clinical characteristics, youth were 84% less likely to be hospitalized if SI was their principal diagnosis and were more likely hospitalized if coded for severe mental illness, substance use, anxiety, or depression, or had ED visits to children's or behavioral health hospitals. This study documents child ED SI visits in Illinois spiked in 2019, with an additional surge in hospitalizations during the pandemic. Rapidly rising hospital use may reflect worsening mental illness and continued difficulty in accessing low cost, high-quality outpatient mental health services.

Mental health legislation: a defect in Cameroon's health system

The collaborative care model (CoCM) is a strategy of integrating behavioral health into primary care to expand access to high-quality mental health services in areas with few psychiatrists. CoCM is multifaceted, and its implementation is accelerating in high-resource settings. However, in low-resource settings, it may not be feasible to implement all CoCM components. Guidance is lacking on CoCM implementation when only some of its components are feasible. In this column, the authors used a cost-benefit approach to refine strategies for addressing common implementation challenges, incorporating the authors' experiences in what was gained and what was lost at each implementation step in three CoCM programs in diverse clinical settings in rural Nepal.

BackgroundWith the growing need for accessible, high-quality mental health services, especially during the COVID-19 pandemic, there has been increasing development and uptake of web-based interventions in the form of self-directed mental health platforms. The Big White Wall (BWW) is a web-based platform for people experiencing mental illness and addiction that offers a range of evidence-based self-directed treatment strategies. Drawing on existing data from a large-scale evaluation of the implementation of BWW in Ontario, Canada (which involved a pragmatic randomized controlled trail with an embedded qualitative process evaluation), we sought to investigate the influences on the extent to which people engage with BWW.MethodsIn this paper we drew on BWW trial participants’ usage data (number of logins) and the qualitative data from the process evaluation that explored participants’ experiences, engagement with and reactions to BWW.ResultsOur results showed that there were highly complex relationships between the influences that contributed to the level of engagement with BWW intervention. We found that a) how people expected to benefit from using a platform like BWW was an important indicator of their future usage, b) moderate perceived symptoms were linked with higher engagement; whereas fewer actual depressive symptoms predicted use and anxiety had a positive linear relationship with usage, and that c) usage depended on positive early experiences with the platform.ConclusionsOur findings suggest that the nature of engagement with platforms such as BWW is not easily predicted. We propose a theoretical framework for explaining the level of user engagement with BWW that might also be generalizable to other similar platforms.